Polyp of intestine
Last reviewed: 23.04.2024
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Polyp of the intestine is any proliferation of tissue from the intestinal wall and protrudes into its lumen. Most often, polyps are asymptomatic, with the exception of minor bleeding, which is usually hidden. The main danger is the possibility of malignant degeneration; most colon cancers arise from benign adenomatous polyps. The diagnosis is made with endoscopy. Treatment of the polyp of the intestine - endoscopic removal of polyps.
Polyps can grow on a wide base or on a pedicle and vary considerably in size. The incidence of polyps is from 7 to 50%; a higher percentage are very small polyps (usually hyperplastic polyps or adenomas) found on autopsy. Polyps, often multiple, develop usually in the rectum and sigmoid colon and their frequency decreases in the proximal direction to the caecum. Multiple polyps can be a family adenomatous polyposis. Approximately 25% of patients with colon cancer have associated adenomatous polyps.
Adenomatous (neoplastic) polyps cause the greatest concern. Such pathological changes are classified histologically into tubular (tubular) adenomas, tubular-villous adenomas (villous-ferruginous polyps) and villous adenomas. The likelihood of malignancy of the adenomatous polyp during the time after detection depends on the size, histological type and degree of dysplasia; tubular adenoma 1.5 cm has a 2% risk of malignancy, compared to 35% of the risk of villous adenoma 3 cm in size.
Non-adenomatous (non-neoplastic) polyps include hyperplastic polyps, hamartomas, juvenile polyps, pseudopolypes, lipomas, leiomyomas and other more rare tumors. Peits-Egers syndrome is an autosomal dominant disease with multiple hamartic polyps in the stomach, small and large intestine. Symptoms of the intestinal polyp include melatonic pigmentation of the skin and mucous membranes, especially the lips and gums. Juvenile polyps are observed in children and, as a rule, their blood supply grows and is self-amputated for some time or after the onset of puberty. Treatment is required only with bleeding, not amenable to conservative therapy, or with intussusception. Inflammation of polyps and pseudopolyposis are observed in chronic ulcerative colitis and with Crohn's disease of the colon. Multiple juvenile polyps (but not single sporadic ones) increase the risk of developing cancer. A certain number of polyps, leading to an increased risk of malignancy, is unknown.
[Symptoms of the polyp of the intestine
Most polyps are asymptomatic. Rectal bleeding, usually latent and rarely massive, is the most frequent complaint. Spastic abdominal pain or obstruction can develop with large polyps. Polyps of the rectum can be palpated in finger research. Sometimes polyps on a long leg prolapse through the anus. Large villous adenomas sometimes cause watery diarrhea, which can lead to hypokalemia.
Diagnosis of the polyp of the intestine
The diagnosis is usually established with a colonoscopy. Irrigoscopy, especially double contrasting, is informative, but colonoscopy is preferable because of the possibility of removing polyps during the study. Since the polyps of the rectum are often multiple and can be combined with cancer, complete colonoscopy to the caecum is necessary, even if the lesion of the distal intestine is detected by a flexible sigmoidoscope.
What do need to examine?
How to examine?
Treatment of the polyp of the intestine
The polyp of the intestine should be completely removed by means of a loop or electrosurgical biopsy forceps during a total colonoscopy; complete removal is especially important for large villous adenomas, which have a high malignancy potential. If the colonoscopic removal of the polyp is impossible, laparotomy is indicated.
The subsequent treatment of the intestinal olive depends on the histological evaluation of the neoplasm. If the dysplastic epithelium does not penetrate the muscular layer, the line of resection along the polyp stalk is clearly visible, the formation is clearly differentiated, then an endoscopic removal is performed, which is quite sufficient. With a deeper germination of the epithelium, fuzzy line of resection or poor differentiation of the lesion, segmental resection of the large intestine is necessary. Since the invasion of the epithelium through the muscular layer provides access to the lymphatic vessels and increases the potential for metastasis to the lymph nodes, such patients need to undergo further examination (as in colon cancer, see below).
The definition of subsequent studies after polypectomy is controversial. Most authors recommend conducting a total colonoscopy every year for 2 years (or irrigoscopy, if total colonoscopy is not possible) with the removal of newly discovered formations. If two annual studies do not reveal new formations, a colonoscopy is recommended 1 time in 2-3 years.
How to prevent the polyp of the intestine?
Prevent the polyp of the intestine can. Aspirin and COX-2 inhibitors can be effective in preventing the occurrence of new polyps in patients with polyps or colon cancer.